Intraoperative precision of 25-Gauge Beveled-Tip versus 23-Gauge Flat-Tip Probes in Day Surgery Vitrectomy for Proliferative Diabetic Retinopathy: A Comparative Cohort Study

Intraoperative precision of 25-Gauge Beveled-Tip versus 23-Gauge Flat-Tip Probes in Day Surgery Vitrectomy for Proliferative Diabetic Retinopathy: A Comparative Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intraoperative precision of 25-Gauge Beveled-Tip versus 23-Gauge Flat-Tip Probes in Day Surgery Vitrectomy for Proliferative Diabetic Retinopathy: A Comparative Cohort Study Daxi Xue, Yanchun Zhang, Ziwei Kang, Jiamin Zheng, Yingnan He, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6646550/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background To compare the intraoperative precision of 10k/25-gauge (G) beveled-tip probe (BTP) versus 5k/23-G flat-tip probe (FTP) vitrectomy for the treatment of proliferative diabetic retinopathy (PDR). Methods This comparative cohort interventional case series study enrolled 173 eyes with PDR in 156 consecutive patients who underwent vitrectomy with either 10k/25-G BTP (study group) or 5k/23-G FTP (control group) by the same surgeon from April 2022 to June 2023. All patients were followed for at least three months after surgery. Intraoperative videos were recorded, and the differences in the demographics, electrocoagulation rate, instrument exchange, actual vitrectomy time, and postoperative complications were evaluated. Results No significant differences were found between the two groups in all baseline and most operative characteristics, including surgery and vitrectomy time, use of endo tamponade agent, occurrence of abnormal postoperative intraocular pressure, best corrected visual acuity (BCVA) improvement, recurrent severe vitreous hemorrhage and other complications. Significantly fewer sclerotomies sutures, instrument exchange, and use of bipolar endo diathermy were observed in the 25-G group. Conclusions Both 23-G FTP and 25-G BTP have comparable visual and anatomical outcomes in MIVS in day surgery for treating PDR patients. Compared with the 23-G FTP, which usually exploits suction to lift and shave the proliferative membranes, the 25-G BTP could directly remove the proliferative membranes using the “ Trim and Excision ” technique, which is safer to reduce the risk of iatrogenic vascular rupture and intraoperative bleeding, as well as decrease the intraoperative exchange of instruments and sclerotomy sutures. Clinical Trial Registration: This trial is registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn, registration number ChiCTR2300067743). Date of registration: 2023-01-20. Proliferative diabetic retinopathy Vitrectomy 10k/25-G beveled-tip probe 5k/23-G flat-tip probe Day surgery Endodiathermy Figures Figure 1 Figure 2 Background Proliferative diabetic retinopathy (PDR) is a severe condition that can result in significant vision loss if left untreated. Pars plana vitrectomy (PPV) is typically recommended for chronic, non-clearing vitreous hemorrhage or severe fibrovascular proliferation (FVP) with tractional retinal detachment (TRD), taut posterior hyaloid traction contributing to nonresolving macular edema or macular hole, or neovascular glaucoma (NVG) requiring advanced intraocular laser treatment( 1 ). The release of vitreous traction and managing the fibrovascular membrane is essential in diabetic surgery. Medical professionals utilize two general techniques to address fibrovascular membranes: segmentation and delamination. In clinical practice, many surgeons prefer the stiffness and maneuverability of the 23-gauge system for most surgeries, using the 25-gauge system occasionally and the 27-gauge system rarely( 2 ). However, in some situations, using a traditional 23-G probe with a flat tip to remove the fibrovascular membrane is impossible or too risky due to tight adherence or mobile retina. Exploring more effective and safer methods to address vitreoretinal adhesions between the retina and fibrovascular proliferation is crucial. Regarding the reparation of complicated vitreoretinal abnormalities, 25-G PPV can provide several benefits compared to larger gauge systems. Small gauge instrumentation can precisely segment and delaminate fibrovascular tissue( 3 , 4 ). With an improved design of a beveled tip and a high cutting rate capacity of 10000cpm, Advanced ULTRAVIT® probes theoretically provide strong technical support for the application of minimally invasive vitrectomy surgery (MIVS), with improved efficiency and safety( 5 , 6 ). However, there is a lack of evidence comparing the intraoperative precision of the Advanced UltraVit 10k/25-G beveled-tip probe (BTP) and the 5k/23-G flat-tip probe (FTP) in PPV for PDR patients in day surgery. To address this gap, we conducted a prospective, interventional, consecutive cohort study, using a retrospective cohort as the comparative group. Our goal was to evaluate and compare the intraoperative precision, efficiency, and postoperative outcomes of the 10k/25-G BTP and the 5k/23-G FTP in day surgery for treating PDR patients. Methods A total of 173 consecutive eyes (156 patients, 69 females, 87 males) underwent primary vitrectomy day surgery for PDR between April 2022 and June 2023 were studied. All surgeries were performed by the same surgeon (Zhang YC). This study was conducted adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Xi’an people’s Hospital. Written informed consent was received from all participants. PDR patients with type II diabetes mellitus and with recurrent or persistent vitreous hemorrhage or dense macular subhyaloid hemorrhage, or with progressive FVP affecting or threatening the macula, or resulting in tractional and/or teared RD, or with iris erythema or NVG were included in the study. Exclusion Criteria included: 1) previous vitreoretinal surgical procedures; 2) a history of any other retinal or choroidal disorders, such as primary rhegmatogenous retinal detachment, uveitis, retinal vascular occlusion, exudative age-related macular degeneration; 3) hypotony (IOP < 6mmHg) at baseline; 4) primary glaucoma; and 5)uncontrolled systemic disease. The control group was a consecutive retrospective cohort based on the matched medical and surgical recordings from April 2022 to Jan. 2023. The patients in the experimental group were consecutive and prospectively enrolled from Jan. to June 2023. Participants with both eyes were allowed to enroll two eyes in the study. Baseline demographics data such as age, gender, previous laser coagulation and anti-VEGF treatment history, type of diabetes, and systemic features included HbA1c, systolic arterial pressure (SAP), and diastolic arterial pressure (DAP), and estimated glomerular filtration rate (eGFR) were collected. Treatment and vitrectomy Before surgery, the surgeon evaluated the eyes that had not received an intravitreal anti-VEGF injection within the previous month and determined whether there was a need for an adjuvant anti-VEGF injection. The preoperative anti-VEGF agents were only advised to those cases with active FVP (if the FVP contained visible neovascularization tissue or associated with any degree of VH classified as “active”, otherwise it would be regarded as “mainly fibrotic”) or with massive fresh and active hemorrhage in the vitreous, and in patients medically cleared for surgery. The anti-VEGF drug was selected based on the wishes of the patients and their families, including aflibercept (Eylea; Regeneron, Tarrytown, NY; and Bayer, Leverkusen, Germany), ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA), or conbercept (KH902; Chengdu Kanghong Biotech Co., Ltd., Sichuan, China). The time from anti-VEGF injection to PPV was set between 3 to 5 days post-injection. Vitrectomy was performed under retrobulbar anesthesia or general anesthesia in day surgery using a Constellation device (Alcon, Fort Worth, TX). Eighty-seven consecutive eyes were operated by 23-G vitrectomy (Alcon Surgical), and the cutting rate was 5000 cuts per min (cpm) with FTP (Control group), and 86 consecutive eyes were operated by 25-G vitrectomy (Alcon Surgical), and the cutting rate was 10000 cuts per min (cpm) with BTP (Experimental group). The linear aspiration employed in the control group ranged from 0 to 550 mmHg, while it extended from 0 to 650 mmHg in the experimental group. intraocular pressure control setting on the Alcon Constellation device was turned on throughout the surgical procedure. All patients underwent vitrectomy with removal of the peripheral vitreous and proliferative membranes. Techniques included segmentation, delamination, lift and shave( 4 ), bimanual techniques, and viscodissection were used when necessary. The IOP in the vitrectomy machine was set at 26 mmHg in all cases and was raised to 60 mmHg for about 1 ~ 3 minutes if bleeding occurred during the vitrectomy. If the hemostasis was still severe and active, intraocular bipolar electrocoagulation was used. Further, endo laser pan-retinal photocoagulation was performed in all eyes during PPV. Intraocular tamponade was performed using sterile air, gas (9% perfluoropropane, C3F8; Alcon Laboratories), or silicone oil, if necessary. At the end of the operation, 0.05ml triamcinolone acetonide was injected into the vitreous. After removing each cannula, the sclerotomy roof was compressed with forceps to close the wound. When sclerotomy was leaking or tamponade with silicon oil, closed the wound with 8 − 0 Vicryl suture. Simultaneous cataract phacoemulsification surgery was conducted when the lens’ opacity obstructs fundus observation or in patients 60 years or older. Operation videos recorded the intraoperative data. Operation time was defined as the time to perform the whole surgical procedure. Actual vitrectomy time was defined as the time taken to perform core and peripheral vitrectomy and fibrovascular membrane wholly processed, which started from the first insertion of the cutter and ended with the last extraction of the cutter from the port. In contrast, the time of specific procedures, such as retinal photocoagulation, tamponade agent placement, and incision closure, are excluded from the whole operation time. Preoperative and postoperative examinations All patients' data from comprehensive ophthalmic examinations were reviewed, including refraction (KR-8900, Topcon, Japan), best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, intraocular pressure (IOP), fundus, swept-source OCT (DRI-OCT, Topcon, Japan), B-scan ultrasonography were optimized. Follow-up was performed at one day, two weeks, one month, two months, and three months postoperatively. If present, postoperative complications, including hypotony (≤ 6 mmHg), ocular hypertension (≥ 25 mmHg)( 7 ), retinal detachment, endophthalmitis, and choroidal detachment were also detailed. The "complexity score" (CS) and the FVP grade were used to evaluate the cases' severity at baseline. The CS was quantified by the number of quadrants of fibrovascular proliferation, the location of FVP, and the presence of TRD, TRD with rhegmatogenous (TRRD), posterior vitreous detachment (PVD) in the macular area (8) . The extent of FVP was separated into four grades based on the severity of vitreoretinal adhesion: Grade 1. Multiple-point adhesions with or without plaque-like broad adhesion at one site; Grade 2. Broad adhesions in more than one but fewer than three sites located posterior to the equator; Grade 3. Broad adhesions in more than three sites, located posterior to the equator or extending beyond the equator within one quadrant; Grade 4. Broad adhesions extending beyond the equator for more than one quadrant (9) . Outcome measures The outcome measures were intraoperative characteristics obtained from the surgery video, including the number of intraoperative bleeding sites being electrocoagulation, the total operation time, vitrectomy time, and the number of instruments exchanged through the ports during vitrectomy (including endo diathermy probe, forceps, scissors, backflush instruments, visco-dissection cannula, and others). Other intraoperative information (type of tamponade agent, combined cataract surgery, the occurrence of iatrogenic retinal tears), BCVA changes and IOP, postoperative complications were also analyzed. Statistics Statistical analyses were conducted using SPSS version 21 (SPSS, Inc., Chicago, IL) and GraphPad Prism 10 (Graphpad Software, LLC.). Descriptive statistics were presented as mean ± standard deviation (SD) or percentage. Chi-squared test for independent variable or Mann–Whitney test was used to compare two groups. Paired t-test was used in intragroup comparisons. P values less than 0.05 were considered to be statistically significant. Result The study included a total of 173 eyes (156 patients). Table 1 presents the baseline demographics and ocular characteristics of the two groups. Notably, there were no significant differences between the two groups in terms of key factors such as gender, age, diabetes mellitus (DM) duration, hypertension ratio, HbA1c, eGFR, preoperative BCVA, IOP, pseudo-phakic/phakic ratio, previous treatment with PRP and anti-VEGF intravitreous injection (IVI) before one month, and the underlying ocular diseases of iris erythema and NVG. Table 1 Characteristics of the Patients Included in This Study 23-gauge 25-gauge P No. [eyes (patients)] 87 (81) 86 (80) Female/male (n) 35/46 36/44 0.82a Age (Yrs) [Mean ± SD (Range)] 51.9 ± 10.9 (25 ~ 73) 52.9 ± 10.9 (25 ~ 79) 0.72b Course of DM (Yrs) [Mean ± SD (Range)] 11.8 ± 6.4 (0.3 ~ 25) 12.3 ± 6.4 (0.5 ~ 30) 0.63b Hypertension [n (%)] 47 (54.0%) 51 (59.3%) 0.48a HbA1c(%) [Mean ± SD (Range)] 7.6 ± 1.5 (4.4~12.0) 7.8 ± 1.4 (5.4~10.8) 0.56b eGFR [Mean ± SD (Range)] 70.6 ± 29.4 (7.6 ~ 136.9) 71.9 ± 33.0 (4.9 ~ 125.6) 0.67b OD/OS (n) 40/47 38/47 0.88 a Baseline BCVA (LogMAR）(Mean ± SD) 1.86 ± 0.96 1.69 ± 0.90 0.23 b Baseline IOP (mmHg) (Mean ± SD) 14.7 ± 6.2 14.4 ± 3.9 0.70 b previous ophthalmologic treatment history PRP [n (%)] 41 (47.13%) 45 (52.33%) 0.49 a Anti-VEGF IVI history [>1month, n (%)] 19 (21.84%) 22 (25.58%) 0.60 a Pseudo-phakic/phakic ratio (n) 7/80 10/76 0.46 a Underlying Disease iris erythema [n (%)] 1 (1.1%) 1 (1.2%) >0.99 c NVG 4 (4.6%) 3 (3.5%) Pre-OP IVI Anti-VEGF (<1 month) Total, n (%) 57 (65.5%) 55 (64.0%) 0.87 a Aflibercept, n(%) 22 (25.3%) 15 (17.4%) 0.63 a Ranibizumab, n(%) 29 (33.3%) 34 (40.0%) Conbercept, n(%) 6 (6.9%) 6 (7.0%) Time of anti-VEGF IVI before PPV (d) [Mean ± SD (Range)] 7.3 ± 5.2 (3 ~ 27) 5.7 ± 2.9 (3 ~ 23) 0.14 b CS [Mean ± SD (Range)] 4.03 ± 2.45 (0 ~ 8) 4.20 ± 2.47 (0 ~ 8) 0.66 b FVP grading 1, n(%) 24 (27.6%) 21 (24.4%) 0.78 a 2, n(%) 18 (20.7%) 14 (16.3%) 3, n(%) 32 (36.8%) 37 (43.0%) 4, n(%) 13 (14.9%) 14 (16.3%) Abbreviations: DM: diabetes mellitus, HbA1c：glycosylated hemoglobin, eGFR：estimated glomerular filtration rate, SD: standard deviation, Pre-OP: pre-operative, LogMAR: logarithm of minimal angle of resolution, IOP: intraocular pressure, PRP: pan-retinal photocoagulation, VEGF: vascular endothelial growth factor, IVI: intravitreal injection, NVG: neovascular glaucoma, CS：preoperative complexity score, FVP: fibrovascular proliferation. a Chi-squared test for independent variable, b Mann-Whitney test, c Fisher's exact test Because some patients had received anti-VEGF in other hospitals before visiting our hospital, we calculated the number of anti-VEGF IVI eyes within one month before PPV. The two groups had no statistically significant differences in preoperative anti-VEGF injection within 30 days and the interval time. The number of patients who had intravitreal injections longer than one week before vitrectomy surgery, those who had injections within one week of surgery, and those who had no injections within one month did not differ significantly (p = 0.49). The CS ranged from 0 to 8 in both groups, with the distribution of 6, 10, 13, 10, 9, 10, 13, 7, 9 eyes in 23-G group and 6, 9, 11, 10, 8, 11, 14, 7, 10 eyes in 25-G group, respectively. The two groups showed no significant statistical difference in CS. The extent of FVP of the two groups ranged from level 1 to level 4. Although the study group contained more severe FVP cases than the control group, there was no statistical difference between the two groups. The two groups had no significant difference in the percentage of simultaneous cataract surgery (p = 0.60) or the type of intraocular tamponade agent used (p = 0.75) (Table 2). Table 2 Comparison of intraoperative parameters between the two groups 23-gauge 25-gauge P No. Of eyes 87 86 Phacovitrectomy rate [n (%)] 47 (54.0%) 43 (50.0%) 0.60 a Intraocular tamponade BSS [n (%)] 10 (11.5%) 11 (12.8%) Air [n (%)] 50 (57.5%) 52 (60.5%) 0.90 a Gas [n (%)] 11 (12.7%) 8 (9.3%) SO [n (%)] 16 (18.4%) 15 (17.4%) Eyes sutured sclerotomies, n (%) 73 (83.9%) 20 (23.3%) <0.0001 a*** Operation time (min) [Mean ± SD (Range)] 63.30 ± 18.38 (33 ~ 122) 59.84 ± 19.28 (35 ~ 138) 0.14 b Vitrectomy time (sec) [Mean ± SD (Range)] 2193 ± 932.4 (980 ~ 5100) 2135 ± 995.4 (960 ~ 6960) 0.67 b Membrane forceps used [n (%)] 22 (25.3%) 16 (18.6%) 0.29 a Bimanual techniques used [n (%)] 3 (3.5%) 1 (1.2%) 0.62 a Viscodissection [n (%)] 5 (5.8%) 4 (4.7%) 0.75 a Tool exchanges in vitrectomy Total [Mean ± SD (Range)] 2.22 ± 2.71 (0~15) 1.31 ± 2.02 (0~11) 0.003 b** In FVP grade 1 (mean ± SD) 0.46 ± 0.58 0.14 ± 0.47 0.031 b* In FVP grade 2 (mean ± SD) 1.28 ± 1.37 0.21 ± 0.43 0.002 b** In FVP grade 3 (mean ± SD) 3.22 ± 2.93 1.54 ± 1.35 0.0007 b** * In FVP grade 4 (mean ± SD) 4.31 ± 3.50 3.64 ± 3.39 0.588 b Iatrogenic retinal breaks (mean ± SD) 0.31 ± 0.84 0.20 ± 0.68 0.33 b Abbreviations: BSS, Balanced Salt Solution, SO, silicon oil, CS, complexity score, FVP, fibrovascular proliferation. a Chi-squared test for independent variable, b Mann-Whitney test, c Fisher's exact test, d unpaired t test with Welch correction;*:p<0.05;**:p<0.005;***:p<0.001. However, the sclerotomies suture rate was 83.91% in the 23-G group and 23.26% in the 25-G group, with a significant difference (P < 0.0001). The total operation time was longer in the 23-G group (63.30 ± 18.38 vs. 59.84 ± 19.28 min), but there was no significant difference between groups (P = 0.14). Actual vitrectomy time did not differ significantly (2193 ± 932.4 vs. 2135 ± 995.4 sec, p = 0.67) (Table 2). When stratified by FVP grade, as shown in Fig1, the time for operation and PPV increased as the FVP grading increased in both groups, and there were no differences in different grades (p>0.05). During the operation, the percentages of membrane forceps, bimanual manipulation, or viscodissection applied between the two groups did not differ significantly (p = 0.29, 0.62, 0.75, respectively). However, the mean number of tool exchanges during vitrectomy was 2.22 ± 2.71 in the 23-G group and 1.31 ± 2.02 in the 25-G group, with significant statistical differences (p = 0.003). The exchanged tools were further analyzed by FVP grade, and the results showed that with the FVP grading increased, the vitrectomy needed more different tools. There were significant differences in grades 1, 2, and 3 between two groups (p = 0.031, 0.002, 0.001, respectively) and no differences in grade 4 (p = 0.588). The most common intraoperative complication was iatrogenic retinal breaks that occurred during membrane removal, and the numbers of iatrogenic breaks were not statistically significant between the groups (0.31 ± 0.84 vs. 0.20 ± 0.68; p = 0.33). There were no other intraoperative severe complications (Table 2). As shown in Table 3, when we focus on endo diathermy, the percentage of eyes that required the use of endo diathermy for hemostasis was fewer in the 25-G group than 23-G group (52.33% vs. 67.82%, p=0.04, Fig. 2a). The endo diathermy probe applied to eyes ranged from 0-5 times (1.20 ± 1.18) in the 23-G group and 0-4 times (0.72 ± 0.94) in the 25-G group, with a significant difference between the two groups (P = 0.003, Fig. 2b). On the other hand, when the diathermy sites were counted and compared, the 25-G group showed a significantly lower number than the 23-G group. The difference was evident not only in the whole cohort (23-G, 5.49 ± 6.49 vs. 25-G, 2.28 ± 3.33; p < 0.0001, Fig. 2c), but also in eyes that received endo diathermy (23-G, 7.83 ± 6.49 vs. 25-G, 4.92 ± 3.36; p = 0.04). The differences in electrocoagulation sites between the two groups according to different FVP grading were further compared, and the results showed a significant difference in the eyes with FVP from grade 1 to grade 3 (p 0.05, Fig. 2d). Table 3 Comparison of endodiathermy for hemostasis between 23- and 25-G groups 23-gauge 25-gauge P Eyes used endo diathermy In all eyes [n (%)] 59/87 (67.8%) 45/86 (52.3%) 0.04 a* In FVP grade 1 [n (%)] 10/24 (41.67%) 1/21 (4.76%) 0.005 c ** In FVP grade 2 [n (%)] 10/18 (55.56%) 3/14 (21.43%) 0.08 c In FVP grade 3 [n (%)] 29/32 (90.63%) 28/37 (67.57%) 0.04 c * In FVP grade 4 [n (%)] 10/13 (76.92%) 11/14 (78.57%) >0.9999 c Frequency of endo diathermy usage In all eyes (Mean ± SD) 1.20 ± 1.18 0.72 ± 0.94 0.003 b* In electrocoagulation eyes (Mean ± SD) 1.76 ± 1.02 1.56 ± 0.79 0.41 b No. Of diathermy sites In all eyes [Mean ± SD] 5.49 ± 6.49 2.28 ± 3.33 <0.0001 b *** In electrocoagulation eyes Total [Mean ± SD] 7.83 ± 6.49 4.92 ± 3.36 0.04 b* In FVP grade 1 [mean ± SD] 1.17 ± 1.81 0.05 ± 0.22 0.006 d*** In FVP grade 2 [mean ± SD] 3.72 ± 5.03 0.36 ± 0.74 0.01 d** In FVP grade 3 [mean ± SD] 8.91 ± 7.32 3.54 ± 3.81 0.0005 d*** In FVP grade 4 [mean ± SD] 7.54 ± 6.55 4.29 ± 3.24) 0.12 d Abbreviations: SD: standard deviation, FVP: fibrovascular proliferation. a Chi-squared test for independent variable, b Mann-Whitney test, c Fisher's exact test, d unpaired t test with Welch correction;*:p<0.05;**:p<0.005;***:p<0.001. Details of the postoperative status of the patients are shown in Table 4. BCVA tended to get better as postoperative follow-up time increased gradually. However, there was no significant difference in BCVA, IOL, the occurrence of ocular hypertension and hypotony between the two groups after vitrectomy at different follow-up points (p>0.05). During the follow-up period, no recurrent postoperative vitreous hemorrhage (PVH) was detected on postoperative day 1 and week 2 in either group. In the 25-G group, two eyes suffered PVH by postoperative month 1, with one eye resolving spontaneously by postoperative month 2. The other patient was hospitalized in another hospital due to a concomitant severe respiratory infectious disease until his follow-up visit in the third postoperative month, at which time his cornea was blood-stained, and the patient opted to discontinue further treatment. On the other hand, one eye in the 23-G group encountered significant PVH with obscured fundus at postoperative month 3. The incidence of PVH did not vary significantly across the different follow-up periods (p>0.05). One eye in the 23-G group developed a severe corneal epithelial defect two monts postoperatively, which healed with amniotic membrane coverage therapy. There was no other postoperative severe complication such as endophthalmitis, intra or postoperative choroidal detachment, or suprachoroidal hemorrhage. Table 4 Comparisons of post-operative results and complication between the two groups 23-gauge 25-gauge P No. of eyes 87 86 BCVA improvement at 3 mos (logMAR) (mean ± SD) 0.93 ± 1.06 0.77 ± 1.08 0.75 b Postoperative IOP, mean ± SD (range) 1 day 16.11 ± 6.55 (5.8~41.3) 15.60 ± 7.41 (6.2~44.4) 0.27 b 2 weeks 16.69 ± 7.37 (8~53.6) 15.37 ± 5.03 (8.6~41.8) 0.41 b 3 months 14.77 ± 3.68 (6.4~29.0) 13.95 ± 4.06(6.0~31.9) 0.11 b Postoperative ocular hypertension / hypotony [n (%)] 1 day 6/1(6.90/1.15%) 6/0(6.98/0%) >0.999 c 2 weeks 5/0(5.75/0%) 3/0(3.49/0%) 0.72 c 3 months 1/0(1.15/0%) 1/0(1.16/0%) >0.999 c Postoperative Serious VH recurrence 2 weeks 0(0%) 0(0%) >0.999 c 1 month 0(0%) 2(2.33%) 0.25 c 2 months 0(0%) 0(0%) >0.999 c 3 months 1(1.15%) 0(0%) >0.999 c Other complications during the postoperative 3 months [n (%)] Serious corneal epithelial damage 1(1.15%) 0(0%) >0.999 c Abbreviations: VA: visual acuity, IOP: intraocular pressure, VH: vitreous hemorrhage, NVG: new vascular glaucoma. a Chi-squared test for independent variable, b Mann-Whitney test, c Fisher's exact test Discussion The typical proliferated diabetic vitreoretinal interface is extremely complicated, so the main difficulty is the multiple dense adhesions between the ischemic retina and fibrovascular membrane embedded in the altered posterior hyaloid cortex accompanied by the neovascular pegs. Besides segmentation and delamination, multiple strategies and techniques, including bimanual techniques, trimanual vitrectomy(10) and highly elastic substance dissection(11), are attempted to gently remove the fibrovascular proliferation from the retina in some complex diabetic vitrectomy cases. Therefore, multiple ancillary instruments, including micro forceps, scissors, and chandelier lighting systems, are necessary for surgical success. With the advent of a microincision vitrectomy system, an all-probe lift and shave technique of fibrovascular dissection minimizes the need for ancillary instrumentation(4). The disadvantages of these techniques are excessive hemorrhage and the risk of iatrogenic retinal tears if performed too aggressively(12). Uncontrolled intraoperative bleeding increases surgical time and may lead to intraoperative complications. Diathermy may be needed in these cases to cauterize neovascular pegs to limit bleeding. With the evolution of systems and the improvement of instruments, the microincisional vitrectomy system (MIVS, 23-, 25-, and 27-G) has been embraced as standards for vitreoretinal surgery, although perspectives differ regarding which is the superior option. Recently, several studies indicate that the utilization of 23-G instrumentation has been progressively decreasing in favor of smaller-gauge systems such as 25-G and even 27-G platforms, which provide benefits such as minimized sclerotomy tissue damage, lowered rates of post-operative hypotony, and reduced post-operative inflammation(13-15), making them increasingly suitable for a wide range of vitreoretinal procedures(16). Since its introduction in 2002 by Fujii et al.(17), 25-G vitrectomy has been extensively utilized for almost all surgical indications. The smaller radius of 25-G tubing, with high cutting rates and valved cannulas, ensures a stable and controlled dissection of membranes with minimum movement of the underlying retina(18). This stability reduces the risk of iatrogenic retinal breaks(19), providing reassurance to the audience about its safety. Nonetheless, numerous surgeons continue to prefer the 23-G instrument for complex vitreous surgeries in clinical practice because the larger bore results in enhanced instrument functionality with more rigid shafts, swifter and more efficient cutters, brighter light conduits, extrusion cannulas that offer improved suction, and a range of multipurpose instruments within the 23-gauge framework compared to smaller-gauge alternatives. To this point, only a handful of reports on beveled-tip MIVS have been published(5, 20-22). We evaluated the intraoperative precision of 10k/25-G BTP versus 5k/23-G FTP vitrectomy conducted in day surgery for PDR, yielding noteworthy results. Despite the 25-G probe's diameter being smaller than that of the 23-G probe, there was no statistically significant difference in total operation time and actual vitrectomy duration. Furthermore, the vitrector effectively eliminated the majority of fibrovascular proliferation, while membrane forceps were predominantly employed to remove the residual membranes above the optic papilla in both cohorts. Bimanual and viscodissection techniques were rarely used in our two cohort cases. This study suggests that there is no significant difference in postoperative intraocular pressure, intra- and post-operative complications, surgical success, and visual outcomes between the two groups, which aligns with prior research findings(23, 24). Nevertheless, there was a significant difference between the two groups regarding surgical sutures, which may increase patient comfort(25, 26). The number of mean tool exchanges during the operation showed significant differences between the groups. Further comparisons revealed a statistically significant difference in the usage frequency of bipolar endo diathermy and the number of diathermy sites between the two groups. During PPV surgery in PDR eyes, endo diathermy is usually used for severe and active hemorrhage, which often occurs when peeling the fibrovascular proliferating plaques, especially with iatrogenic retinal and (or) vascular breaks. So, retinal electrocoagulation can reflect the degree and scope of retinal bleeding in PDR vitrectomy. The results showed that the 25-G BTP system has a unique advantage in reducing the incidence of intra-operative bleeding. To the best of our knowledge, this has been scarcely addressed in prior literature concerning PDR operations. Previous research demonstrated that the dynamic IOP measurements and control system in Alcon Constellation device could attenuate IOP fluctuations during vitrectomy procedures, and there was no significant disparity in IOP fluctuations between 23- and 25-gauge systems(27). Therefore, the impact of IOP fluctuations on the occurrence of intra-operative bleeding is minimal or inconsequential. Compared with the FTP of 23-G, the reduced circumference, beveled compact tip allow for better access within tight tissue planes near the retina, and the high cutting rate of 10K helps conformal cutter delamination. Therefore, the BTP of 25-G is more suited to be used as a multifunctional tool, such as a pick to lift tissue, as forceps to peel tissues with aspiration, as viscoelastic to blunt dissection with beveled tip, and as scissors to segment and delaminate with probe into the crevices of epiretinal vascular bridges. This not only reduces the need for ancillary instrumentation(3) but also provides a safer and more delicate dissection of abnormal posterior hyaloid and fibrovascular membranes directly by trimming around the base of tightly adherent proliferative membrane pegs with minimal aspiration, avoiding damage to the stretched deformed vessels attached to the root of the proliferating tissues by careful identification, and eventual removing all proliferative tissues, we call it as Trim and Excision technique, which decrease the dependence on lifting or peeling abnormal tissues from the retina by aspiration or forceps. Although the Trim and Excision technique may seem to take longer for removing proliferative membranes compared to lifting or peeling them, it actually results in fewer iatrogenic vascular breaks, which can save operative time. Additionally, the higher cutting speed of 10K and the lower incisional suture rate balance out the smaller diameter in 25-G system, leading to similar surgical times. At the same time, the reduction in intraoperative hemorrhage and the need for electrocoagulation are undoubtedly significant for protecting the extremely weakened retina and retinal blood vessels. In this study, the occurrence of both immediate and recurrent PVH was relatively minimal in comparison to earlier reports(28, 29), potentially attributable to the infrequency of postoperative hypotony, most eyes received Anti-VEGF IVI prior to the operation, adequate hemostasis during surgery, and the neovascularization at the sclerotomy site may be diminished due to the small dimensions and microcannula system of 23-G and 25-G. This research encountered certain limitations. The observed time is only three months, and the control group consisted of a retrospective cohort, whereas the study group was a prospective cohort, which may intrinsically introduce a bias when compared to a prospective randomized controlled trial. Nevertheless, the eyes under investigation were derived from a consecutive cohort, and the severity of the two groups was assessed using various PDR grading methods, including CS and FVP grading. The clinical attributes and operation-related variables of the two groups at baseline were comparable, indicating a well-balanced study design. This evidently diminished selection bias. Furthermore, the variability in technique was considerably reduced because all operations were performed by a single experienced vitreoretinal surgeon, who has conducted over 3,000 PPV procedures, with nearly half related to PDR in the past decade. Conclusion In conclusions, the study confirms that during day surgery for treating PDR patients, both 23-G FTP and 25-G BTP have comparable visual and anatomic results. However, compared to the 5k/23-G FTP, the 10K/25-G BTP provide the chance to perform a Trim and Excision technique to address the complex preretinal membrane and firm vitreoretinal adhesions more precisely, leading to less risk of iatrogenic vascular damage and less use of endo diathermy, with higher accuracy and safety. Abbreviations BCVA: Best corrected visual acuity BTP: beveled-tip probe CS: preoperative complexity score DAP: diastolic arterial pressure eGFR: estimated glomerular filtration rate FTp: flat-tip probe HbA1c: glycosylated hemoglobin IOP: intraocular pressure IVI: intravitreal injection LogMAR: logarithm of minimal angle of resolution, MIVS: micro-incisional vitrectomy system NVG: neovascular glaucoma, PDR: proliferative diabetic retinopathy PPV: pars plana vitrectomy Pre-OP: pre-operative PRP: pan-retinal photocoagulation SAP: systolic arterial pressure SD: standard deviation SO: silicon oil TRD: tractional retinal detachment VEGF: vascular endothelial growth factor VH: vitreous hemorrhage Declarations Ethics approval and consent to participate All measurements performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and Declaration of Helsinki. The Ethics Committee of Xi'an People's Hospital (Xi'an Fourth Hospital) approved the study protocol (serial number: 20220143). All participants were informed about related issues of this study and signed written informed consent. Consent for publication All participants in this study were informed of the relevant questions and signed an informed consent form, agreeing to the collection and use of their personal data, including personal details, images, and videos related to the study. All intraoperative photographs and imaging materials have been de-identified by removing metadata and any identifiable facial features. Availability of data and materials The clinical data supporting this study are available from Xi'an People's Hospital (Xi'an Fourth Hospital) Ethics Committee but restrictions apply to the availability of these data. Data are however available from the authors upon reasonable request and with permission of the ethics committee. Competing interests None of the authors has any financial/conflicting interests to disclose. Funding: The study was supported by Alcon Project (IIT#75019437), Xi'an Science and Technology Plan Major Research Project (201805104YX12SF38(3)), The International Diabetes Exchange and Practice Special Foundation(Z-2017-26-2302), and Scientific Research Incubation Foundation of Xi'an People's Hospital (LH-18); Author contributions Yanchun Zhang and Daxi Xue contributed to the study conception and design. Yanchun Zhang conducted the surgery, and prepared and reviewed the manuscript. Material preparation, data collection and analysis were performed by Daxi Xue, Ziwei Kang, Yingnan He, and Jiamin Zheng. The first draft of the manuscript was written by Daxi Xue, Xin Luo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors would like to thank all the patients who participated in this study and the staff of Shaanxi Eye Hospital. References Sano M, Inoue M, Itoh Y, Hirota K, Koto T, Hirakata A. Efficacy of higher cutting rates during microincision vitrectomy for proliferative diabetic retinopathy. Eur J Ophthalmol. 2016;26(4):364-8. Bhavsar AR. Operative Techniques in Vitreoretinal Surgery E-Book: Elsevier Health Sciences; 2022. Mikhail M, Ali-Ridha A, Chorfi S, Kapusta MA. Long-term outcomes of sutureless 25-G+ pars-plana vitrectomy for the management of diabetic tractional retinal detachment. Graefe's Archive for Clinical and Experimental Ophthalmology. 2016;255(2):255-61. Berrocal MH. ALL-PROBE VITRECTOMY DISSECTION TECHNIQUES FOR DIABETIC TRACTIONAL RETINAL DETACHMENTS: Lift and Shave. Retina. 2018;38 Suppl 1:S2-S4. Gerardo G-S, Chow DR. Shovel and Cut Technique: Beveled Vitrectomy Probes to Address Diabetic Tractional Retinal Detachments. Retina. 2023;43(7):1207-8. Uy HS, Cabahug VLO, Artiaga JCM, Chan PS, Famadico JT. Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system. BMC Ophthalmol. 2022;22(1):93. Khan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU, et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016;161:36-43 e1-2. Castellarin A, Grigorian R, Bhagat N, Del Priore L, Zarbin MA. Vitrectomy with silicone oil infusion in severe diabetic retinopathy. Br J Ophthalmol. 2003;87(3):318-21. Huang CH, Hsieh YT, Yang CM. Vitrectomy for complications of proliferative diabetic retinopathy in young adults: clinical features and surgical outcomes. Graefes Arch Clin Exp Ophthalmol. 2017;255(5):863-71. El-Baha SM, Ahmed IS. Trimanual vitrectomy for severe proliferative diabetic retinopathy. International Ophthalmology. 2021;41(5):1717-27. Grigorian RA, Castellarin A, Fegan R, Seery C, Del Priore LV, Von Hagen S, et al. Epiretinal membrane removal in diabetic eyes: comparison of viscodissection with conventional methods of membrane peeling. Br J Ophthalmol. 2003;87(6):737-41. Jackson TL, Johnston RL, Donachie PH, Williamson TH, Sparrow JM, Steel DH. The Royal College of Ophthalmologists' National Ophthalmology Database Study of Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy. JAMA Ophthalmol. 2016;134(1):79-85; quiz 120. Guthrie G, Magill H, Steel DH. 23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes. Ophthalmologica. 2015;233(2):104-11. Saleh OA, Alshamarti SA, Abu-Yaghi NE. Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery. Clin Ophthalmol. 2020;14:1553-8. Stalmans P. A Comparative Study of 23-Gauge and 27-Gauge Vitrectomy for Puckers or Floaters, Including Evaluation of the Effect of Combined Phaco-Vitrectomy Surgery on Postoperative Outcome. Ophthalmologica. 2021;244(3):245-9. Ma J, Wang Q, Niu H. Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis. J Ophthalmol. 2020;2020(1):6149692. Fujii GY, De Juan E, Jr., Humayun MS, Chang TS, Pieramici DJ, Barnes A, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109(10):1814-20. Dugel PU, Abulon DJ, Dimalanta R. Comparison of attraction capabilities associated with high-speed, dual-pneumatic vitrectomy probes. Retina. 2015;35(5):915-20. Chen E. 25-Gauge transconjunctival sutureless vitrectomy. Curr Opin Ophthalmol. 2007;18(3):188-93. Patel S, Nair A, Taubenslag K, Scavelli K, Mallory P, Moreno T, et al. High-speed Beveled Tip Versus Standard Tip Vitrectomy Probe: A Prospective Randomized Clinical Trial. J Ophthalmic Vis Res. 2023;18(4):405-9. Hwang SH, Lee DY, Nam DH. Vitreous cortex remnants removal with beveled vitrectomy probe during vitrectomy for primary rhegmatogenous retinal detachment. Retina. 2023;43(12):2173-6. Liu J, Liu B, Liu J, Wen D, Wang M, Shao Y, et al. Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial. BMC Ophthalmol. 2023;23(1):504. Kumar A, Duraipandi K, Gogia V, Sehra SV, Gupta S, Midha N. Comparative evaluation of 23- and 25-gauge microincision vitrectomy surgery in management of diabetic macular traction retinal detachment. Eur J Ophthalmol. 2014;24(1):107-13. Taleb EA, Nagpal MP, Mehrotra NS, Bhatt K, Goswami S, Babalola YO, et al. Comparison of clinical outcome between 23-G and 25-G vitrectomy in diabetic patients. Oman Journal of Ophthalmology. 2017;10(3):213-9. Thompson JT. Advantages and limitations of small gauge vitrectomy. Surv Ophthalmol. 2011;56(2):162-72. Guthrie G, Magill H, Steel DH. 23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes. Ophthalmologica. 2015;233(2):104-11. Sugiura Y, Okamoto F, Okamoto Y, Hiraoka T, Oshika T. Intraocular Pressure Fluctuation During Microincision Vitrectomy With Constellation Vision System. American Journal of Ophthalmology. 2013;156(5):941-7.e1. McCullough P, Mohite A, Virgili G, Lois N. Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2023;141(2):186-95. Lee BJ, Yu HG. Vitreous hemorrhage after the 25-gauge transconjunctival sutureless vitrectomy for proliferative diabetic retinopathy. Retina. 2010;30(10):1671-7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Aug, 2025 Reviews received at journal 18 Jul, 2025 Reviews received at journal 13 Jul, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers agreed at journal 23 Jun, 2025 Reviewers invited by journal 03 Jun, 2025 Editor assigned by journal 13 May, 2025 Submission checks completed at journal 13 May, 2025 First submitted to journal 12 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6646550","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466288074,"identity":"1370adff-cf37-4580-988d-b7d477910e4d","order_by":0,"name":"Daxi Xue","email":"","orcid":"","institution":"Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University","correspondingAuthor":false,"prefix":"","firstName":"Daxi","middleName":"","lastName":"Xue","suffix":""},{"id":466288075,"identity":"e52cad8b-c6a9-4b7d-91de-d840fbc23bef","order_by":1,"name":"Yanchun Zhang","email":"data:image/png;base64,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","orcid":"","institution":"Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University","correspondingAuthor":true,"prefix":"","firstName":"Yanchun","middleName":"","lastName":"Zhang","suffix":""},{"id":466288076,"identity":"ec6e1882-9f53-4036-b570-859bdb8f8066","order_by":2,"name":"Ziwei Kang","email":"","orcid":"","institution":"Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University","correspondingAuthor":false,"prefix":"","firstName":"Ziwei","middleName":"","lastName":"Kang","suffix":""},{"id":466288077,"identity":"0c0b177e-af5c-44a6-ad3a-e316683a5094","order_by":3,"name":"Jiamin Zheng","email":"","orcid":"","institution":"Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University","correspondingAuthor":false,"prefix":"","firstName":"Jiamin","middleName":"","lastName":"Zheng","suffix":""},{"id":466288081,"identity":"8326acdf-a92d-41d2-8f31-cc832e2b9a04","order_by":4,"name":"Yingnan He","email":"","orcid":"","institution":"Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University","correspondingAuthor":false,"prefix":"","firstName":"Yingnan","middleName":"","lastName":"He","suffix":""},{"id":466288082,"identity":"3b15eaae-782d-40ef-9a21-f05a48a7f156","order_by":5,"name":"B. S. Xin Luo","email":"","orcid":"","institution":"Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University","correspondingAuthor":false,"prefix":"","firstName":"B.","middleName":"S. Xin","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2025-05-12 12:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6646550/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6646550/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84220494,"identity":"f306c754-4367-4d88-ac9b-a39c7f952d7a","added_by":"auto","created_at":"2025-06-09 11:33:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":619071,"visible":true,"origin":"","legend":"\u003cp\u003eThe scatter plot comparing total (a) and PPV (b) time by FVP grade for two groups\u003c/p\u003e\n\u003cp\u003eThe black line shows at median. GraphPad Prism 10 (Graphpad Software, LLC.) was used to create the artwork. Abbreviations: PPV: pars plana vitrectomy; FVP: fibrovascular proliferation\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6646550/v1/96c798ac82c76d72e685c8fa.png"},{"id":84220117,"identity":"41651ae8-502a-4a6d-88ba-1d1de9b932b4","added_by":"auto","created_at":"2025-06-09 11:25:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1021150,"visible":true,"origin":"","legend":"\u003cp\u003eThe use of bipolar electrocoagulation in the 23-G and 25-G groups The number of electrocoagulation eyes in the two groups (a), The difference between the mean frequency of intraoperative electrocoagulation used in the two groups (b), The estimation plot showing the number of electrocoagulation sites in each eye (c), The violin plot of electrocoagulation sites according to different FVP grade (d). GraphPad Prism 10 (Graphpad Software, LLC.) was used to create the artwork. Abbreviations: FVP: fibrovascular proliferation\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6646550/v1/64f8cd2572739f7d78956e75.png"},{"id":84221250,"identity":"c4915049-d746-42ac-ad79-e8e7a238bbd5","added_by":"auto","created_at":"2025-06-09 11:49:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2391208,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6646550/v1/d1bc42aa-6d6f-44f5-9112-29e2f0331560.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intraoperative precision of 25-Gauge Beveled-Tip versus 23-Gauge Flat-Tip Probes in Day Surgery Vitrectomy for Proliferative Diabetic Retinopathy: A Comparative Cohort Study","fulltext":[{"header":"Background","content":"\u003cp\u003eProliferative diabetic retinopathy (PDR) is a severe condition that can result in significant vision loss if left untreated. Pars plana vitrectomy (PPV) is typically recommended for chronic, non-clearing vitreous hemorrhage or severe fibrovascular proliferation (FVP) with tractional retinal detachment (TRD), taut posterior hyaloid traction contributing to nonresolving macular edema or macular hole, or neovascular glaucoma (NVG) requiring advanced intraocular laser treatment(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The release of vitreous traction and managing the fibrovascular membrane is essential in diabetic surgery. Medical professionals utilize two general techniques to address fibrovascular membranes: segmentation and delamination. In clinical practice, many surgeons prefer the stiffness and maneuverability of the 23-gauge system for most surgeries, using the 25-gauge system occasionally and the 27-gauge system rarely(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, in some situations, using a traditional 23-G probe with a flat tip to remove the fibrovascular membrane is impossible or too risky due to tight adherence or mobile retina. Exploring more effective and safer methods to address vitreoretinal adhesions between the retina and fibrovascular proliferation is crucial.\u003c/p\u003e \u003cp\u003eRegarding the reparation of complicated vitreoretinal abnormalities, 25-G PPV can provide several benefits compared to larger gauge systems. Small gauge instrumentation can precisely segment and delaminate fibrovascular tissue(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). With an improved design of a beveled tip and a high cutting rate capacity of 10000cpm, Advanced ULTRAVIT\u0026reg; probes theoretically provide strong technical support for the application of minimally invasive vitrectomy surgery (MIVS), with improved efficiency and safety(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, there is a lack of evidence comparing the intraoperative precision of the Advanced UltraVit 10k/25-G beveled-tip probe (BTP) and the 5k/23-G flat-tip probe (FTP) in PPV for PDR patients in day surgery. To address this gap, we conducted a prospective, interventional, consecutive cohort study, using a retrospective cohort as the comparative group. Our goal was to evaluate and compare the intraoperative precision, efficiency, and postoperative outcomes of the 10k/25-G BTP and the 5k/23-G FTP in day surgery for treating PDR patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA total of 173 consecutive eyes (156 patients, 69 females, 87 males) underwent primary vitrectomy day surgery for PDR between April 2022 and June 2023 were studied. All surgeries were performed by the same surgeon (Zhang YC). This study was conducted adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Xi\u0026rsquo;an people\u0026rsquo;s Hospital. Written informed consent was received from all participants.\u003c/p\u003e \u003cp\u003ePDR patients with type II diabetes mellitus and with recurrent or persistent vitreous hemorrhage or dense macular subhyaloid hemorrhage, or with progressive FVP affecting or threatening the macula, or resulting in tractional and/or teared RD, or with iris erythema or NVG were included in the study. Exclusion Criteria included: 1) previous vitreoretinal surgical procedures; 2) a history of any other retinal or choroidal disorders, such as primary rhegmatogenous retinal detachment, uveitis, retinal vascular occlusion, exudative age-related macular degeneration; 3) hypotony (IOP\u0026thinsp;\u0026lt;\u0026thinsp;6mmHg) at baseline; 4) primary glaucoma; and 5)uncontrolled systemic disease.\u003c/p\u003e \u003cp\u003eThe control group was a consecutive retrospective cohort based on the matched medical and surgical recordings from April 2022 to Jan. 2023. The patients in the experimental group were consecutive and prospectively enrolled from Jan. to June 2023. Participants with both eyes were allowed to enroll two eyes in the study. Baseline demographics data such as age, gender, previous laser coagulation and anti-VEGF treatment history, type of diabetes, and systemic features included HbA1c, systolic arterial pressure (SAP), and diastolic arterial pressure (DAP), and estimated glomerular filtration rate (eGFR) were collected.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTreatment and vitrectomy\u003c/h2\u003e \u003cp\u003eBefore surgery, the surgeon evaluated the eyes that had not received an intravitreal anti-VEGF injection within the previous month and determined whether there was a need for an adjuvant anti-VEGF injection. The preoperative anti-VEGF agents were only advised to those cases with active FVP (if the FVP contained visible neovascularization tissue or associated with any degree of VH classified as \u0026ldquo;active\u0026rdquo;, otherwise it would be regarded as \u0026ldquo;mainly fibrotic\u0026rdquo;) or with massive fresh and active hemorrhage in the vitreous, and in patients medically cleared for surgery. The anti-VEGF drug was selected based on the wishes of the patients and their families, including aflibercept (Eylea; Regeneron, Tarrytown, NY; and Bayer, Leverkusen, Germany), ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA), or conbercept (KH902; Chengdu Kanghong Biotech Co., Ltd., Sichuan, China). The time from anti-VEGF injection to PPV was set between 3 to 5 days post-injection.\u003c/p\u003e \u003cp\u003eVitrectomy was performed under retrobulbar anesthesia or general anesthesia in day surgery using a Constellation device (Alcon, Fort Worth, TX). Eighty-seven consecutive eyes were operated by 23-G vitrectomy (Alcon Surgical), and the cutting rate was 5000 cuts per min (cpm) with FTP (Control group), and 86 consecutive eyes were operated by 25-G vitrectomy (Alcon Surgical), and the cutting rate was 10000 cuts per min (cpm) with BTP (Experimental group). The linear aspiration employed in the control group ranged from 0 to 550 mmHg, while it extended from 0 to 650 mmHg in the experimental group. intraocular pressure control setting on the Alcon Constellation device was turned on throughout the surgical procedure. All patients underwent vitrectomy with removal of the peripheral vitreous and proliferative membranes. Techniques included segmentation, delamination, lift and shave(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), bimanual techniques, and viscodissection were used when necessary. The IOP in the vitrectomy machine was set at 26 mmHg in all cases and was raised to 60 mmHg for about 1\u0026thinsp;~\u0026thinsp;3 minutes if bleeding occurred during the vitrectomy. If the hemostasis was still severe and active, intraocular bipolar electrocoagulation was used. Further, endo laser pan-retinal photocoagulation was performed in all eyes during PPV. Intraocular tamponade was performed using sterile air, gas (9% perfluoropropane, C3F8; Alcon Laboratories), or silicone oil, if necessary. At the end of the operation, 0.05ml triamcinolone acetonide was injected into the vitreous. After removing each cannula, the sclerotomy roof was compressed with forceps to close the wound. When sclerotomy was leaking or tamponade with silicon oil, closed the wound with 8\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl suture. Simultaneous cataract phacoemulsification surgery was conducted when the lens\u0026rsquo; opacity obstructs fundus observation or in patients 60 years or older. Operation videos recorded the intraoperative data. Operation time was defined as the time to perform the whole surgical procedure. Actual vitrectomy time was defined as the time taken to perform core and peripheral vitrectomy and fibrovascular membrane wholly processed, which started from the first insertion of the cutter and ended with the last extraction of the cutter from the port. In contrast, the time of specific procedures, such as retinal photocoagulation, tamponade agent placement, and incision closure, are excluded from the whole operation time.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePreoperative and postoperative examinations\u003c/h3\u003e\n\u003cp\u003eAll patients' data from comprehensive ophthalmic examinations were reviewed, including refraction (KR-8900, Topcon, Japan), best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, intraocular pressure (IOP), fundus, swept-source OCT (DRI-OCT, Topcon, Japan), B-scan ultrasonography were optimized. Follow-up was performed at one day, two weeks, one month, two months, and three months postoperatively. If present, postoperative complications, including hypotony (\u0026le;\u0026thinsp;6 mmHg), ocular hypertension (\u0026ge;\u0026thinsp;25 mmHg)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), retinal detachment, endophthalmitis, and choroidal detachment were also detailed.\u003c/p\u003e \u003cp\u003eThe \"complexity score\" (CS) and the FVP grade were used to evaluate the cases' severity at baseline. The CS was quantified by the number of quadrants of fibrovascular proliferation, the location of FVP, and the presence of TRD, TRD with rhegmatogenous (TRRD), posterior vitreous detachment (PVD) in the macular area\u003csup\u003e(8)\u003c/sup\u003e. The extent of FVP was separated into four grades based on the severity of vitreoretinal adhesion: Grade 1. Multiple-point adhesions with or without plaque-like broad adhesion at one site; Grade 2. Broad adhesions in more than one but fewer than three sites located posterior to the equator; Grade 3. Broad adhesions in more than three sites, located posterior to the equator or extending beyond the equator within one quadrant; Grade 4. Broad adhesions extending beyond the equator for more than one quadrant\u003csup\u003e(9)\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eThe outcome measures were intraoperative characteristics obtained from the surgery video, including the number of intraoperative bleeding sites being electrocoagulation, the total operation time, vitrectomy time, and the number of instruments exchanged through the ports during vitrectomy (including endo diathermy probe, forceps, scissors, backflush instruments, visco-dissection cannula, and others). Other intraoperative information (type of tamponade agent, combined cataract surgery, the occurrence of iatrogenic retinal tears), BCVA changes and IOP, postoperative complications were also analyzed.\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eStatistical analyses were conducted using SPSS version 21 (SPSS, Inc., Chicago, IL) and GraphPad Prism 10 (Graphpad Software, LLC.). Descriptive statistics were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or percentage. Chi-squared test for independent variable or Mann\u0026ndash;Whitney test was used to compare two groups. Paired t-test was used in intragroup comparisons. P values less than 0.05 were considered to be statistically significant.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eThe study included a total of 173 eyes (156 patients). Table\u0026nbsp;1 presents the baseline demographics and ocular characteristics of the two groups. Notably, there were no significant differences between the two groups in terms of key factors such as gender, age, diabetes mellitus (DM) duration, hypertension ratio, HbA1c, eGFR, preoperative BCVA, IOP, pseudo-phakic/phakic ratio, previous treatment with PRP and anti-VEGF intravitreous injection (IVI) before one month, and the underlying ocular diseases of iris erythema and NVG.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e Characteristics of the Patients Included in This Study\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo. [eyes (patients)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale/male (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35/46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36/44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.82a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (Yrs) [Mean \u0026plusmn; SD (Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.9 \u0026plusmn; 10.9 (25 ~ 73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.9 \u0026plusmn; 10.9 (25 ~ 79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCourse of DM (Yrs) [Mean \u0026plusmn; SD\u0026nbsp;(Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.8 \u0026plusmn; 6.4 (0.3 ~ 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3 \u0026plusmn; 6.4 (0.5\u0026nbsp;~\u0026nbsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.63b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHypertension [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (54.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51 (59.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.48a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHbA1c(%)\u0026nbsp;[Mean \u0026plusmn; SD (Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.6 \u0026plusmn; 1.5 (4.4~12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.8 \u0026plusmn; 1.4 (5.4~10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eeGFR\u0026nbsp;[Mean \u0026plusmn; SD (Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70.6 \u0026plusmn; 29.4 (7.6\u0026nbsp;~\u0026nbsp;136.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.9 \u0026plusmn; 33.0 (4.9\u0026nbsp;~\u0026nbsp;125.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.67b\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOD/OS\u0026nbsp;(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38/47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.88\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBaseline BCVA (LogMAR）(Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.86 \u0026plusmn;\u0026nbsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.69 \u0026plusmn;\u0026nbsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.23\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBaseline IOP (mmHg)\u0026nbsp;(Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.7 \u0026plusmn;\u0026nbsp;6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4 \u0026plusmn;\u0026nbsp;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.70\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eprevious ophthalmologic treatment history\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePRP\u0026nbsp;[n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41 (47.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45 (52.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.49\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnti-VEGF IVI\u0026nbsp;history\u0026nbsp;[\u0026gt;1month,\u0026nbsp;n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (21.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (25.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.60\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePseudo-phakic/phakic ratio (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7/80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10/76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.46\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eUnderlying Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eiris erythema [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNVG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003ePre-OP IVI Anti-VEGF (\u0026lt;1 month)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57 (65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55 (64.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.87\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAflibercept, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.63\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRanibizumab, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConbercept, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTime of anti-VEGF IVI before PPV (d)\u0026nbsp;[Mean \u0026plusmn; SD\u0026nbsp;(Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.3 \u0026plusmn;\u0026nbsp;5.2\u0026nbsp;(3\u0026nbsp;~\u0026nbsp;27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.7 \u0026plusmn;\u0026nbsp;2.9 (3\u0026nbsp;~\u0026nbsp;23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.14\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS\u0026nbsp;[Mean \u0026plusmn; SD\u0026nbsp;(Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.03 \u0026plusmn; 2.45 (0\u0026nbsp;~\u0026nbsp;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.20 \u0026plusmn; 2.47\u0026nbsp;(0 ~ 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.66\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eFVP grading\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (24.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.78\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (43.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: DM: diabetes mellitus, HbA1c：glycosylated hemoglobin, eGFR：estimated glomerular filtration rate,\u0026nbsp;SD: standard deviation, Pre-OP: pre-operative,\u0026nbsp;LogMAR: logarithm of minimal angle of resolution,\u0026nbsp;IOP: intraocular pressure,\u0026nbsp;PRP: pan-retinal photocoagulation,\u0026nbsp;VEGF: vascular endothelial growth factor,\u0026nbsp;IVI: intravitreal injection,\u0026nbsp;NVG:\u0026nbsp;neovascular glaucoma,\u0026nbsp;CS：preoperative complexity score,\u0026nbsp;FVP: fibrovascular proliferation.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eChi-squared test for independent variable, \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eMann-Whitney test, \u003csup\u003ec\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eFisher\u0026apos;s exact test\u003c/p\u003e\n\u003cp\u003eBecause some patients had received anti-VEGF in other hospitals before visiting our hospital, we calculated the number of anti-VEGF IVI eyes within one month before PPV. The two groups had no statistically significant differences in preoperative anti-VEGF injection within 30 days and the interval time. The number of patients who had intravitreal injections longer than one week before vitrectomy surgery, those who had injections within one week of surgery, and those who had no injections within one month did not differ significantly (p = 0.49).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe CS ranged from 0 to 8 in both groups, with the distribution of 6, 10, 13, 10, 9, 10, 13, 7, 9 eyes in 23-G group and 6, 9, 11, 10, 8, 11, 14, 7, 10 eyes in 25-G group, respectively. The two groups showed no significant statistical difference in CS. The extent of FVP of the two groups ranged from level 1 to level 4. Although the study group contained more severe FVP cases than the control group, there was no statistical difference between the two groups. The two groups had no significant difference in the percentage of simultaneous cataract surgery (p = 0.60) or the\u0026nbsp;type of intraocular\u0026nbsp;tamponade agent used (p\u0026nbsp;=\u0026nbsp;0.75) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u0026nbsp; Comparison of intraoperative parameters between the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e23-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e25-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo. Of eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003ePhacovitrectomy rate [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e47 (54.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e43 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.60\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eIntraocular tamponade\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eBSS [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e11 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eAir\u0026nbsp;[n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e50 (57.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e52 (60.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.90\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eGas\u0026nbsp;[n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e11 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e8 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eSO\u0026nbsp;[n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e15 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eEyes sutured sclerotomies,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e73 (83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e20 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003csup\u003ea***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eOperation time (min) [Mean \u0026plusmn; SD (Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e63.30 \u0026plusmn; 18.38 (33 ~ 122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e59.84 \u0026plusmn; 19.28 (35 ~ 138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.14\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eVitrectomy time (sec)\u0026nbsp;[Mean \u0026plusmn; SD (Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2193 \u0026plusmn;\u0026nbsp;932.4 (980\u0026nbsp;~\u0026nbsp;5100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e2135 \u0026plusmn;\u0026nbsp;995.4 (960\u0026nbsp;~\u0026nbsp;6960)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.67\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eMembrane forceps used [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e22 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e16 (18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.29\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eBimanual techniques used\u0026nbsp;[n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.62\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eViscodissection [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e5 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e4 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.75\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eTool exchanges in vitrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Total [Mean \u0026plusmn; SD (Range)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2.22 \u0026plusmn; 2.71 (0~15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.31 \u0026plusmn; 2.02\u0026nbsp;(0~11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003csup\u003eb**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eIn FVP grade 1 (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.46 \u0026plusmn; 0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.14 \u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.031\u003csup\u003eb*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eIn FVP grade 2 (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.28 \u0026plusmn; 1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.21 \u0026plusmn; 0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003csup\u003eb**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eIn FVP grade 3 (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.22 \u0026plusmn; 2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.54 \u0026plusmn; 1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0007\u003csup\u003eb**\u003c/sup\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eIn FVP grade 4 (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4.31 \u0026plusmn; 3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e3.64 \u0026plusmn; 3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.588\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 208px;\"\u003e\n \u003cp\u003eIatrogenic retinal breaks (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.31 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.20 \u0026plusmn; 0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.33\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: BSS, Balanced Salt Solution, SO, silicon oil, CS, complexity score, FVP, fibrovascular proliferation.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eChi-squared test for independent variable, \u003csup\u003eb\u003c/sup\u003eMann-Whitney test, \u003csup\u003ec\u003c/sup\u003eFisher\u0026apos;s exact test,\u003csup\u003ed\u003c/sup\u003eunpaired t test with Welch correction;*:p\u0026lt;0.05;**:p\u0026lt;0.005;***:p\u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003eHowever, the sclerotomies suture rate was 83.91% in the 23-G group and 23.26% in the 25-G group, with a significant difference (P\u0026nbsp;\u0026lt;\u0026nbsp;0.0001). The total operation time was longer in the 23-G group\u0026nbsp;(63.30 \u0026plusmn; 18.38 vs. 59.84 \u0026plusmn; 19.28 min), but there was no significant difference between groups (P = 0.14). Actual vitrectomy time did not differ significantly (2193 \u0026plusmn; 932.4 vs. 2135 \u0026plusmn; 995.4 sec, p\u0026nbsp;=\u0026nbsp;0.67) (Table 2). When stratified by FVP grade, as shown in Fig1, the time for operation and PPV increased as the FVP grading increased in both groups, and there were no differences in different grades (p\u0026gt;0.05). During the operation, the percentages of membrane forceps, bimanual manipulation, or viscodissection applied between the two groups did not differ significantly (p = 0.29, 0.62, 0.75, respectively). However, the mean number of tool exchanges during vitrectomy was 2.22 \u0026plusmn; 2.71 in the 23-G group and 1.31 \u0026plusmn; 2.02 in the 25-G group, with significant statistical differences (p\u0026nbsp;=\u0026nbsp;0.003). The exchanged tools were further analyzed by FVP grade, and the results showed that with the FVP grading increased, the vitrectomy needed more different tools. There were significant differences in grades 1, 2, and 3 between two groups (p = 0.031, 0.002, 0.001, respectively) and no differences in grade 4 (p = 0.588). The most common intraoperative complication was iatrogenic\u0026nbsp;retinal breaks that occurred during membrane removal, and the numbers of iatrogenic\u0026nbsp;breaks were not statistically significant between the groups (0.31 \u0026plusmn; 0.84 vs. 0.20 \u0026plusmn; 0.68; p = 0.33). There were no other intraoperative severe complications (Table 2).\u003c/p\u003e\n\u003cp\u003eAs shown in Table 3, when we focus on endo diathermy, the percentage of eyes that required the use of endo diathermy for hemostasis was fewer in the 25-G group than 23-G group (52.33% vs. 67.82%, p=0.04, Fig. 2a). The endo diathermy probe applied to eyes ranged from 0-5 times (1.20 \u0026plusmn; 1.18) in the 23-G group and 0-4 times (0.72 \u0026plusmn; 0.94) in the 25-G group, with a significant difference between the two groups (P = 0.003, Fig. 2b). On the other hand, when the diathermy sites were counted and compared, the 25-G group showed a significantly lower number than the 23-G group. The difference was evident not only in the whole cohort (23-G, 5.49 \u0026plusmn; 6.49 vs. 25-G, 2.28 \u0026plusmn; 3.33; p \u0026lt; 0.0001, Fig. 2c), but also in eyes that received endo diathermy (23-G, 7.83 \u0026plusmn; 6.49 vs. 25-G, 4.92 \u0026plusmn; 3.36; p = 0.04). The differences in electrocoagulation sites between the two groups according to different FVP grading were further compared, and the results showed a significant difference in the eyes with FVP from grade 1 to grade 3 (p \u0026lt; 0.05), though no difference in the eyes with FVP grade 4 (p \u0026gt; 0.05, Fig. 2d).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e Comparison of endodiathermy for hemostasis between 23- and 25-G groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e23-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e25-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 568px;\"\u003e\n \u003cp\u003eEyes used endo diathermy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn all eyes [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e59/87 (67.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e45/86 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.04\u003csup\u003ea*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 1 [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e10/24 (41.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1/21 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.005\u003csup\u003ec\u003c/sup\u003e\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 2 [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e10/18 (55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e3/14 (21.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.08\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 3 [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e29/32 (90.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e28/37 (67.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.04\u003csup\u003ec\u003c/sup\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 4 [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e10/13 (76.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e11/14 (78.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026gt;0.9999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eFrequency of endo diathermy usage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn all eyes (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e1.20 \u0026plusmn; 1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.72 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003csup\u003eb*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn electrocoagulation eyes (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e1.76 \u0026plusmn; 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e1.56 \u0026plusmn; 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.41\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 568px;\"\u003e\n \u003cp\u003eNo. Of diathermy sites\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn all eyes\u0026nbsp;[Mean \u0026plusmn; SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e5.49 \u0026plusmn;\u0026nbsp;6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e2.28 \u0026plusmn;\u0026nbsp;3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003csup\u003eb\u003c/sup\u003e\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 568px;\"\u003e\n \u003cp\u003eIn electrocoagulation eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;[Mean \u0026plusmn; SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e7.83 \u0026plusmn;\u0026nbsp;6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e4.92 \u0026plusmn; 3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.04\u003csup\u003eb*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 1\u0026nbsp;[mean \u0026plusmn; SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e1.17 \u0026plusmn; 1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.05 \u0026plusmn; 0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003csup\u003ed***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 2\u0026nbsp;[mean \u0026plusmn; SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e3.72 \u0026plusmn;\u0026nbsp;5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e0.36 \u0026plusmn;\u0026nbsp;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.01\u003csup\u003ed**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 3\u0026nbsp;[mean \u0026plusmn; SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e8.91 \u0026plusmn;\u0026nbsp;7.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e3.54 \u0026plusmn;\u0026nbsp;3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0005\u003csup\u003ed***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 243px;\"\u003e\n \u003cp\u003eIn FVP grade 4\u0026nbsp;[mean \u0026plusmn; SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e7.54 \u0026plusmn;\u0026nbsp;6.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e4.29 \u0026plusmn;\u0026nbsp;3.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.12\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: SD: standard deviation, FVP: fibrovascular proliferation.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eChi-squared test for independent variable, \u003csup\u003eb\u003c/sup\u003eMann-Whitney test, \u003csup\u003ec\u003c/sup\u003eFisher\u0026apos;s exact test,\u003csup\u003ed\u003c/sup\u003eunpaired t test with Welch correction;*:p\u0026lt;0.05;**:p\u0026lt;0.005;***:p\u0026lt;0.001.\u003c/p\u003e\n\u003cp\u003eDetails of the postoperative status of the patients are shown in Table 4. BCVA tended to get better as postoperative follow-up time increased gradually. However, there was no significant difference in BCVA, IOL, the occurrence of ocular hypertension and hypotony between the two groups after vitrectomy at different follow-up points (p\u0026gt;0.05). During the follow-up period, no recurrent postoperative vitreous hemorrhage (PVH) was detected on postoperative day 1 and week 2 in either group. In the 25-G group, two eyes suffered PVH by postoperative month 1, with one eye resolving spontaneously by postoperative month 2. The other patient was hospitalized in another hospital due to a concomitant severe respiratory infectious disease until his follow-up visit in the third postoperative month, at which time his cornea was blood-stained, and the patient opted to discontinue further treatment. On the other hand, one eye in the 23-G group encountered significant PVH with obscured fundus at postoperative month 3. The incidence of PVH did not vary significantly across the different follow-up periods (p\u0026gt;0.05). One eye in the 23-G group developed a severe corneal epithelial defect two monts postoperatively, which healed with amniotic membrane coverage therapy. There was no other postoperative severe complication such as endophthalmitis, intra or postoperative choroidal detachment, or suprachoroidal hemorrhage. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e Comparisons of post-operative results and complication between the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e23-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e25-gauge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eNo. of eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eBCVA improvement at 3\u003c/p\u003e\n \u003cp\u003emos (logMAR) (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.93 \u0026plusmn; 1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0.77 \u0026plusmn; 1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.75\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePostoperative IOP, mean \u0026plusmn; SD (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e1 day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e16.11 \u0026plusmn; 6.55 (5.8~41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e15.60 \u0026plusmn; 7.41 (6.2~44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.27\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e16.69 \u0026plusmn; 7.37 (8~53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e15.37 \u0026plusmn; 5.03 (8.6~41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.41\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e14.77 \u0026plusmn; 3.68 (6.4~29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e13.95 \u0026plusmn; 4.06(6.0~31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.11\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePostoperative ocular hypertension / hypotony [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e1 day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e6/1(6.90/1.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e6/0(6.98/0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e5/0(5.75/0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e3/0(3.49/0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.72\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e1/0(1.15/0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e1/0(1.16/0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePostoperative Serious VH recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 153px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e2(2.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.25\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e1(1.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003eOther complications during the postoperative 3 months [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eSerious corneal epithelial damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e1(1.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026gt;0.999\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: VA:\u0026nbsp;visual acuity,\u0026nbsp;IOP: intraocular pressure, VH: vitreous hemorrhage, NVG: new vascular glaucoma.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eChi-squared test for independent variable, \u003csup\u003eb\u003c/sup\u003eMann-Whitney test, \u003csup\u003ec\u003c/sup\u003eFisher\u0026apos;s exact test\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe typical proliferated diabetic vitreoretinal interface is extremely complicated, so the main difficulty is the multiple dense adhesions between the ischemic retina and fibrovascular membrane embedded in the altered posterior hyaloid cortex accompanied by the neovascular pegs. Besides segmentation and delamination, multiple strategies and techniques, including bimanual techniques, trimanual vitrectomy(10) and highly elastic substance dissection(11), are attempted to gently remove the fibrovascular proliferation from the retina in some complex diabetic vitrectomy cases. Therefore, multiple ancillary instruments, including micro forceps, scissors, and chandelier lighting systems, are necessary for surgical success. With the advent of a microincision vitrectomy system, an all-probe lift and shave technique of fibrovascular dissection minimizes the need for ancillary instrumentation(4). The disadvantages of these techniques are excessive hemorrhage and the risk of iatrogenic retinal tears if performed too aggressively(12). Uncontrolled intraoperative bleeding increases surgical time and may lead to intraoperative complications. Diathermy may be needed in these cases to cauterize neovascular pegs to limit bleeding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWith the evolution of systems and the improvement of instruments, the microincisional vitrectomy system (MIVS, 23-, 25-, and 27-G) has been embraced as standards for vitreoretinal surgery, although perspectives differ regarding which is the superior option. Recently, several studies indicate that the utilization of 23-G instrumentation has been progressively decreasing in favor of smaller-gauge systems such as 25-G and even 27-G platforms, which provide benefits such as minimized sclerotomy tissue damage, lowered rates of post-operative hypotony, and reduced post-operative inflammation(13-15), making them increasingly suitable for a wide range of vitreoretinal procedures(16). Since its introduction in 2002 by Fujii et al.(17), 25-G vitrectomy has been extensively utilized for almost all surgical indications. The smaller radius of 25-G tubing, with high cutting rates and valved cannulas, ensures a stable and controlled dissection of membranes with minimum movement of the underlying retina(18). This stability reduces the risk of iatrogenic retinal breaks(19), providing reassurance to the audience about its safety. Nonetheless, numerous surgeons continue to prefer the 23-G instrument for complex vitreous surgeries in clinical practice because the larger bore results in enhanced instrument functionality with more rigid shafts, swifter and more efficient cutters, brighter light conduits, extrusion cannulas that offer improved suction, and a range of multipurpose instruments within the 23-gauge framework compared to smaller-gauge alternatives.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo this point, only a handful of reports on beveled-tip MIVS have been published(5, 20-22).\u0026nbsp;We evaluated the intraoperative precision of 10k/25-G BTP versus 5k/23-G FTP vitrectomy conducted in day surgery for PDR, yielding noteworthy results. Despite the 25-G probe\u0026apos;s diameter being smaller than that of the 23-G probe, there\u0026nbsp;was no statistically significant difference in total operation time and actual vitrectomy\u0026nbsp;duration.\u0026nbsp;Furthermore, the vitrector\u0026nbsp;effectively eliminated the\u0026nbsp;majority of\u0026nbsp;fibrovascular proliferation,\u0026nbsp;while\u0026nbsp;membrane forceps were\u0026nbsp;predominantly employed to\u0026nbsp;remove the residual membranes above the optic papilla in both\u0026nbsp;cohorts. Bimanual and viscodissection techniques were rarely used in our two cohort cases.\u0026nbsp;This study suggests that there is no significant difference in postoperative intraocular pressure,\u0026nbsp;intra- and post-operative complications, surgical success, and visual outcomes\u0026nbsp;between the two groups, which aligns with prior research findings(23, 24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNevertheless, there was a significant difference between the two groups regarding surgical sutures, which may increase patient comfort(25, 26). The number of mean tool exchanges during the operation showed significant differences between the groups. Further comparisons revealed a statistically significant difference in the usage frequency of bipolar endo diathermy and the number of diathermy sites between the two groups. During PPV surgery in PDR eyes, endo diathermy is usually used for severe and active hemorrhage, which often occurs when peeling the fibrovascular proliferating plaques, especially with iatrogenic retinal and (or) vascular breaks. So, retinal electrocoagulation can reflect the degree and scope of retinal bleeding in PDR vitrectomy. The results showed that the 25-G BTP system has a unique advantage in reducing the incidence of intra-operative bleeding. To the best of our knowledge, this has been scarcely addressed in prior literature concerning PDR operations. Previous research demonstrated that the dynamic IOP measurements and control system in Alcon Constellation device could attenuate IOP fluctuations during vitrectomy procedures, and there was no significant disparity in IOP fluctuations between 23- and 25-gauge systems(27). Therefore, the impact of IOP fluctuations on the occurrence of intra-operative bleeding is minimal or inconsequential. Compared with the FTP of 23-G, the reduced circumference, beveled compact tip allow for better access within tight tissue planes near the retina, and the high cutting rate of 10K helps conformal cutter delamination. Therefore, the BTP\u0026nbsp;of 25-G is more suited to be used as a multifunctional tool, such as a pick to lift tissue, as forceps to peel tissues with aspiration, as viscoelastic to blunt dissection with beveled tip, and as scissors to segment and delaminate with probe into the crevices of epiretinal vascular bridges.\u0026nbsp;This not only reduces the need for ancillary instrumentation(3)\u0026nbsp;but also provides a safer and more delicate dissection of abnormal posterior hyaloid and fibrovascular membranes directly by trimming around the base of tightly adherent proliferative membrane pegs with minimal aspiration, avoiding damage to the stretched deformed vessels attached to the root of the proliferating tissues by careful identification, and eventual removing all proliferative tissues, we call it as Trim and Excision technique, which decrease the dependence on lifting or peeling abnormal tissues from the retina by aspiration or forceps. Although the Trim and Excision technique may seem to take longer for removing proliferative membranes compared to lifting or peeling them, it actually results in fewer iatrogenic vascular breaks, which can save operative time. Additionally, the higher cutting speed of 10K and the lower incisional suture rate balance out the smaller diameter in 25-G system, leading to similar surgical times. At the same time, the reduction in intraoperative hemorrhage and the need for electrocoagulation are undoubtedly significant for protecting the extremely weakened retina and retinal blood vessels.\u0026nbsp;In this study, the occurrence of both immediate and recurrent PVH was relatively minimal in comparison to earlier reports(28, 29), potentially attributable to the infrequency of postoperative hypotony,\u0026nbsp;most eyes received Anti-VEGF IVI prior to the operation, adequate hemostasis during surgery, and the neovascularization at the sclerotomy\u0026nbsp;site may be diminished due to the small dimensions and microcannula system of 23-G and 25-G.\u003c/p\u003e\n\u003cp\u003eThis research encountered certain limitations. The observed time is only three months, and the control group consisted of a retrospective cohort, whereas the study group was a prospective cohort, which may intrinsically introduce a bias when compared to a prospective randomized controlled trial. Nevertheless, the eyes under investigation were derived from a consecutive cohort, and the severity of the two groups was assessed using various PDR grading methods, including CS and FVP grading. The clinical attributes and operation-related variables of the two groups at baseline were comparable, indicating a well-balanced study design. This evidently diminished selection bias. Furthermore, the variability in technique was considerably reduced because all operations were performed by a single experienced vitreoretinal surgeon, who has conducted over 3,000 PPV procedures, with nearly half related to PDR in the past decade.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusions, the study confirms that during day surgery for treating PDR patients, both 23-G FTP and 25-G BTP have comparable visual and anatomic results. However, compared to the 5k/23-G FTP, the 10K/25-G BTP provide the chance to perform a Trim and Excision technique to address the complex preretinal membrane and firm vitreoretinal adhesions more precisely, leading to less risk of iatrogenic vascular damage and less use of endo diathermy, with higher accuracy and safety.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003eBCVA: Best corrected visual acuity\u003c/p\u003e\n\u003cp\u003eBTP: beveled-tip probe\u003c/p\u003e\n\u003cp\u003eCS: preoperative complexity score\u003c/p\u003e\n\u003cp\u003eDAP:\u0026nbsp;diastolic arterial pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eeGFR:\u0026nbsp;estimated glomerular filtration rate\u003c/p\u003e\n\u003cp\u003eFTp: flat-tip probe\u003c/p\u003e\n\u003cp\u003eHbA1c: glycosylated hemoglobin\u003c/p\u003e\n\u003cp\u003eIOP: intraocular pressure\u003c/p\u003e\n\u003cp\u003eIVI: intravitreal injection\u003c/p\u003e\n\u003cp\u003eLogMAR: logarithm of minimal angle of resolution,\u003c/p\u003e\n\u003cp\u003eMIVS: micro-incisional vitrectomy system\u003c/p\u003e\n\u003cp\u003eNVG: neovascular glaucoma,\u003c/p\u003e\n\u003cp\u003ePDR: proliferative diabetic retinopathy\u003c/p\u003e\n\u003cp\u003ePPV: pars plana vitrectomy\u003c/p\u003e\n\u003cp\u003ePre-OP: pre-operative\u003c/p\u003e\n\u003cp\u003ePRP: pan-retinal photocoagulation\u003c/p\u003e\n\u003cp\u003eSAP:\u0026nbsp;systolic arterial pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD: standard deviation\u003c/p\u003e\n\u003cp\u003eSO:\u0026nbsp;silicon oil\u003c/p\u003e\n\u003cp\u003eTRD:\u0026nbsp;tractional retinal detachment\u003c/p\u003e\n\u003cp\u003eVEGF: vascular endothelial growth factor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVH: vitreous hemorrhage\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll measurements performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and Declaration of Helsinki. The Ethics Committee of Xi\u0026apos;an People\u0026apos;s Hospital (Xi\u0026apos;an Fourth Hospital) approved the study protocol (serial number: 20220143). All participants were informed about related issues of this study and signed written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All participants in this study were informed of the relevant questions and signed an informed consent form, agreeing to the collection and use of their personal data, including personal details, images, and videos related to the study. All intraoperative photographs and imaging materials have been de-identified by removing metadata and any identifiable facial features.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical data supporting this study are available from Xi\u0026apos;an People\u0026apos;s Hospital (Xi\u0026apos;an Fourth Hospital) Ethics Committee but restrictions apply to the availability of these data. Data are however available from the authors upon reasonable request and with permission of the ethics committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors has any financial/conflicting interests to\u0026nbsp;disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by Alcon\u0026nbsp;Project (IIT#75019437), Xi\u0026apos;an Science and Technology Plan Major Research Project (201805104YX12SF38(3)), The International Diabetes Exchange and Practice Special Foundation(Z-2017-26-2302), and Scientific Research Incubation Foundation of Xi\u0026apos;an People\u0026apos;s Hospital (LH-18);\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYanchun Zhang and Daxi Xue contributed to the study conception and design. Yanchun Zhang conducted the surgery, and prepared and reviewed the manuscript. Material preparation, data collection and analysis were performed by Daxi Xue, Ziwei Kang, Yingnan He, and Jiamin Zheng. The first draft of the manuscript was written by Daxi Xue, Xin Luo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the patients who participated in this study and the staff of\u0026nbsp;Shaanxi Eye Hospital.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSano M, Inoue M, Itoh Y, Hirota K, Koto T, Hirakata A. Efficacy of higher cutting rates during microincision vitrectomy for proliferative diabetic retinopathy. Eur J Ophthalmol. 2016;26(4):364-8.\u003c/li\u003e\n\u003cli\u003eBhavsar AR. Operative Techniques in Vitreoretinal Surgery E-Book: Elsevier Health Sciences; 2022.\u003c/li\u003e\n\u003cli\u003eMikhail M, Ali-Ridha A, Chorfi S, Kapusta MA. Long-term outcomes of sutureless 25-G+ pars-plana vitrectomy for the management of diabetic tractional retinal detachment. Graefe\u0026apos;s Archive for Clinical and Experimental Ophthalmology. 2016;255(2):255-61.\u003c/li\u003e\n\u003cli\u003eBerrocal MH. ALL-PROBE VITRECTOMY DISSECTION TECHNIQUES FOR DIABETIC TRACTIONAL RETINAL DETACHMENTS: Lift and Shave. Retina. 2018;38 Suppl 1:S2-S4.\u003c/li\u003e\n\u003cli\u003eGerardo G-S, Chow DR. Shovel and Cut Technique: Beveled Vitrectomy Probes to Address Diabetic Tractional Retinal Detachments. Retina. 2023;43(7):1207-8.\u003c/li\u003e\n\u003cli\u003eUy HS, Cabahug VLO, Artiaga JCM, Chan PS, Famadico JT. Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system. BMC Ophthalmol. 2022;22(1):93.\u003c/li\u003e\n\u003cli\u003eKhan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU, et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016;161:36-43 e1-2.\u003c/li\u003e\n\u003cli\u003eCastellarin A, Grigorian R, Bhagat N, Del Priore L, Zarbin MA. Vitrectomy with silicone oil infusion in severe diabetic retinopathy. Br J Ophthalmol. 2003;87(3):318-21.\u003c/li\u003e\n\u003cli\u003eHuang CH, Hsieh YT, Yang CM. Vitrectomy for complications of proliferative diabetic retinopathy in young adults: clinical features and surgical outcomes. Graefes Arch Clin Exp Ophthalmol. 2017;255(5):863-71.\u003c/li\u003e\n\u003cli\u003eEl-Baha SM, Ahmed IS. Trimanual vitrectomy for severe proliferative diabetic retinopathy. International Ophthalmology. 2021;41(5):1717-27.\u003c/li\u003e\n\u003cli\u003eGrigorian RA, Castellarin A, Fegan R, Seery C, Del Priore LV, Von Hagen S, et al. Epiretinal membrane removal in diabetic eyes: comparison of viscodissection with conventional methods of membrane peeling. Br J Ophthalmol. 2003;87(6):737-41.\u003c/li\u003e\n\u003cli\u003eJackson TL, Johnston RL, Donachie PH, Williamson TH, Sparrow JM, Steel DH. The Royal College of Ophthalmologists\u0026apos; National Ophthalmology Database Study of Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy. JAMA Ophthalmol. 2016;134(1):79-85; quiz 120.\u003c/li\u003e\n\u003cli\u003eGuthrie G, Magill H, Steel DH. 23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes. Ophthalmologica. 2015;233(2):104-11.\u003c/li\u003e\n\u003cli\u003eSaleh OA, Alshamarti SA, Abu-Yaghi NE. Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery. Clin Ophthalmol. 2020;14:1553-8.\u003c/li\u003e\n\u003cli\u003eStalmans P. A Comparative Study of 23-Gauge and 27-Gauge Vitrectomy for Puckers or Floaters, Including Evaluation of the Effect of Combined Phaco-Vitrectomy Surgery on Postoperative Outcome. Ophthalmologica. 2021;244(3):245-9.\u003c/li\u003e\n\u003cli\u003eMa J, Wang Q, Niu H. Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis. J Ophthalmol. 2020;2020(1):6149692.\u003c/li\u003e\n\u003cli\u003eFujii GY, De Juan E, Jr., Humayun MS, Chang TS, Pieramici DJ, Barnes A, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109(10):1814-20.\u003c/li\u003e\n\u003cli\u003eDugel PU, Abulon DJ, Dimalanta R. Comparison of attraction capabilities associated with high-speed, dual-pneumatic vitrectomy probes. Retina. 2015;35(5):915-20.\u003c/li\u003e\n\u003cli\u003eChen E. 25-Gauge transconjunctival sutureless vitrectomy. Curr Opin Ophthalmol. 2007;18(3):188-93.\u003c/li\u003e\n\u003cli\u003ePatel S, Nair A, Taubenslag K, Scavelli K, Mallory P, Moreno T, et al. High-speed Beveled Tip Versus Standard Tip Vitrectomy Probe: A Prospective Randomized Clinical Trial. J Ophthalmic Vis Res. 2023;18(4):405-9.\u003c/li\u003e\n\u003cli\u003eHwang SH, Lee DY, Nam DH. Vitreous cortex remnants removal with beveled vitrectomy probe during vitrectomy for primary rhegmatogenous retinal detachment. Retina. 2023;43(12):2173-6.\u003c/li\u003e\n\u003cli\u003eLiu J, Liu B, Liu J, Wen D, Wang M, Shao Y, et al. Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial. BMC Ophthalmol. 2023;23(1):504.\u003c/li\u003e\n\u003cli\u003eKumar A, Duraipandi K, Gogia V, Sehra SV, Gupta S, Midha N. Comparative evaluation of 23- and 25-gauge microincision vitrectomy surgery in management of diabetic macular traction retinal detachment. Eur J Ophthalmol. 2014;24(1):107-13.\u003c/li\u003e\n\u003cli\u003eTaleb EA, Nagpal MP, Mehrotra NS, Bhatt K, Goswami S, Babalola YO, et al. Comparison of clinical outcome between 23-G and 25-G vitrectomy in diabetic patients. Oman Journal of Ophthalmology. 2017;10(3):213-9.\u003c/li\u003e\n\u003cli\u003eThompson JT. Advantages and limitations of small gauge vitrectomy. Surv Ophthalmol. 2011;56(2):162-72.\u003c/li\u003e\n\u003cli\u003eGuthrie G, Magill H, Steel DH. 23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes. Ophthalmologica. 2015;233(2):104-11.\u003c/li\u003e\n\u003cli\u003eSugiura Y, Okamoto F, Okamoto Y, Hiraoka T, Oshika T. Intraocular Pressure Fluctuation During Microincision Vitrectomy With Constellation Vision System. American Journal of Ophthalmology. 2013;156(5):941-7.e1.\u003c/li\u003e\n\u003cli\u003eMcCullough P, Mohite A, Virgili G, Lois N. Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2023;141(2):186-95.\u003c/li\u003e\n\u003cli\u003eLee BJ, Yu HG. Vitreous hemorrhage after the 25-gauge transconjunctival sutureless vitrectomy for proliferative diabetic retinopathy. Retina. 2010;30(10):1671-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Proliferative diabetic retinopathy, Vitrectomy, 10k/25-G beveled-tip probe, 5k/23-G flat-tip probe, Day surgery, Endodiathermy","lastPublishedDoi":"10.21203/rs.3.rs-6646550/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6646550/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo compare the intraoperative precision of 10k/25-gauge (G) beveled-tip probe (BTP) versus 5k/23-G flat-tip probe (FTP) vitrectomy for the treatment of proliferative diabetic retinopathy (PDR).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis comparative cohort interventional case series study enrolled 173 eyes with PDR in 156 consecutive patients who underwent vitrectomy with either 10k/25-G BTP (study group) or 5k/23-G FTP (control group) by the same surgeon from April 2022 to June 2023. All patients were followed for at least three months after surgery. Intraoperative videos were recorded, and the differences in the demographics, electrocoagulation rate, instrument exchange, actual vitrectomy time, and postoperative complications were evaluated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant differences were found between the two groups in all baseline and most operative characteristics, including surgery and vitrectomy time, use of endo tamponade agent, occurrence of abnormal postoperative intraocular pressure, best corrected visual acuity (BCVA) improvement, recurrent severe vitreous hemorrhage and other complications. Significantly fewer sclerotomies sutures, instrument exchange, and use of bipolar endo diathermy were observed in the 25-G group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth 23-G FTP and 25-G BTP have comparable visual and anatomical outcomes in MIVS in day surgery for treating PDR patients. Compared with the 23-G FTP, which usually exploits suction to lift and shave the proliferative membranes, the 25-G BTP could directly remove the proliferative membranes using the “\u003cem\u003eTrim and Excision\u003c/em\u003e” technique, which is safer to reduce the risk of iatrogenic vascular rupture and intraoperative bleeding, as well as decrease the intraoperative exchange of instruments and sclerotomy sutures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration:\u0026nbsp;\u003c/strong\u003eThis trial is registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn, registration number ChiCTR2300067743). Date of registration: 2023-01-20.\u003c/p\u003e","manuscriptTitle":"Intraoperative precision of 25-Gauge Beveled-Tip versus 23-Gauge Flat-Tip Probes in Day Surgery Vitrectomy for Proliferative Diabetic Retinopathy: A Comparative Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 11:25:39","doi":"10.21203/rs.3.rs-6646550/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-07T01:40:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-18T23:12:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-13T08:39:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242064060766012653570246679292529779139","date":"2025-06-25T04:19:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109289671766054819958967757096890878135","date":"2025-06-24T19:00:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266902581365833480227632613160218678672","date":"2025-06-23T12:42:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-03T21:31:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T08:20:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-13T04:19:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Retina and Vitreous","date":"2025-05-12T12:14:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f203c033-0618-4735-a91e-d58b4daed445","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-12T16:53:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 11:25:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6646550","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6646550","identity":"rs-6646550","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}